TEST #1 Study Guide

The Growth of Medical Authority

1. Explain the meaning of “authority” and why physicians did not have it in early American history.

Physicians did not have Authority in early american history is that it involves the surrender of private
judgement and 19th century Americans were not willing to take that surrender to physicians since they
believe that common sense and native intelligence could deal effectively as with most problems of
health and illness.

Authority signifies the possession of special status or claims that compels special trust, and medicine
lacked that claim in 19th century America. Early American history didn’t have it is due to standardization
blocked by internal and or external barriers – sectarianism among medical practioners and a general
resistance to privileged monopolies in the society at large

2. Explain how the change in the institution of education increased medical authority.

Before a system of standardized education and licensing was institutionalized in 20th century, physicians
might win personal authority by their character and intimate knowledge of their patients once it is
institutionalized, it conferred authority upon all who passed through them in short; authority changed
from depending on individuals' attitudes and character to the structure of institutions.

Institution of education is a system that reproduces authority from one generation to the next, and
transmits if from the profession as a whole to all of its individual members.

3. Explain the growth of medical authority and its impact on economic power.

With the growth of medical authority, impact on economic power shifted from family and lay
community becoming secondary to paid practitioners, druggists, hospitals, and other commercial and
professional sources selling their services competitively on the market. Because of this, physicians view
the competitive market as a threat not only to their incomes, but also their status and autonomy and
feel it would turn them into mere employees.

4. Explain contradiction of professionalism and the rule of the market.

The contradiction between the two is that in order to justify the public's trust, professionals have set
higher standards of conduct for themselves than the minimal rules governing the marketplace and
maintain that they can be judged under these standards only. However, when the marketplace gets fully
competitive, markets do not obey that standard. Since in a market, it uses a system exchange in which
goods and services are bought and sold at going prices; there is no relations of dependency in the ideal
market: any individual buyer has free choice of sellers, and any seller is a free choice of buyers, and no
group of buyers is supposed to be able to force acceptance of its terms.
The Rise of the Modern Hospital

5. Explain the operational prerequisites for hospital admission in the 1800s.

Poverty and dependence were the operational perquisites for hospital admissions in the 1800s due to
that during the 19th century, men outnumbered women as patients and in urban America supplied an
abundance of single laboring men providing the bulk of admissions.

6. Explain boundaries between home and hospital in early American history.

The boundaries between the two is that in early American history, the hospitals used during the civil war
surgery was done in wards, early 19th century antebellum hospitals did not have specific spaces adapted
to the treatment of emergency, they had few private rooms but generally insignificant in terms of space
or number of occupants also, limited technology and traditional attitudes.

7. Describe the development of the new kind of hospital in the early 1900s.

The development of the new kind of hospital is that it improved standards such as diagnosis and therapy
to determine hospital admission, technology providing new tools, medical men and medical skills playing
an increasingly important part in the institution. Bureaucracy reshaping the institution's internal order:
trained and disciplined nursing corps, a profesionalizing hospital admininstration, as well as an
increasingly specialized medical profession had all played a role in transforming the 19 th century
hospital.

8. Explain the rise of the segregation of medical knowledge.

Why the US Has No Health Insurance

9. Compare the US with other industrialized nations in the offering of health insurance.

All western counties except the US regardless of how they raise funds, organize care, and determine
eligibility, guarantees citizens comprehensive coverage for essential health care services. Canada’s
private insurance covers items not included in the government programs such as prescription drugs. In
Great Britain, private institutions are for extra services or quicker access to operations. In Denmark,
private institutions cover various supplementary services.

10. Describe the health insurance status of Americans

From 2002 to 2003, nearly 82 million people - “one out of three Americans” went without health
insurance for all or part of every two years due to the complexity of the health insurance marketplace as
well as the high cost of coverage and medical underwriting. Some uninsured people work in jobs not
offering health benefits and even if offered, the uninsured people would refuse due to not being able to
pay their share on premiums. Also uninsured people have reduced access to medical care and have risks
to their health and well-being.

11. Impact of the uninsured on others’ health care

It raises health care for everyone, causing cost shifting in which insurance companies either reduce
coverage services, raise premiums, copayments, and deductibles for people with insurance. Also, as
premium rises, fewer employers offer coverage which means more people wind up uninsured and
would keep repeating itself.

12. Theories of the Welfare State Revisited: Antistatis Values, Weak Labor, Racial Politics, State
Structures and Policy Legacies, Stakeholder Mobilization

- Antistatis values: An anti-statist is one who opposes intervention by the state into personal,
social and economic affairs. public wondered if the Antistatis values were the potent causal
force, why during the 1960s it failed to respond when the AMA used the same themes against
Medicare
 One reason is that Medicare appeared in the agenda in suppurative political climate
 Another there was a counter force when the national council of senior citizens challenged AMA
claims and demonstrated that the aged were worthy of continued constituency

- Weak Labor: unable to mobilize power resources for the working class
 Counter evidence includes the disability insurance and Medicare (important to the labor
movement because they shifted the cost of insuring disabled workers and retirees to the public
purse wages increased and other benefits for working workers in their negotiated contracts.

- Racial politics: have been transmitted in coded messages implying that minorities are
undeserving beneficiaries of social programs.

- State structures and policy legacies: when trying to explain almost everything, they cannot
predict the direction of policy decisions or how preferences and expectations of various groups
get translated into actual policy decisions.

- Stakeholder mobilization: physicians were the deciding voice in health debates because their
political were compatible with other key allies. Their victories show those physicians were an
omnipotent political force.
The Patient in the Intensive Care Unit

13. Explain the meaning of “irrelevance of the patient’s personhood.”

Physicians and nurses focus more on observation and objective measures of laboratory generated data
even if presented with the patients' medical history, often seen as a secondary source or isn't bothered
to be looked at all. They focus more on observing the patient, record info, then go to the next patient,
no interaction between the two.

14. Explain the relationship between “Good medicine” and the denial of personhood.

The relationship between the two is that with good medicine is promoted to be at its best, heroic, and
most pure with physiology alone however, the truth is that most argue that patient is being treated
more like a disease since physicians focus more on a physiological process in which even the underlying
disease is forgotten.

15. Explain relationship of the denial of personhood and moral judgements.

The relationship is that the physicians see themselves not as priests or cops but rather as repairmen
because their job is not to reform behavior or distinguish among patients of varying character but to fix
the person. The moral judgments on physicians and nurses are of little relevance to them; they neither
demeans the patient nor tries to reform them nor for the most part, treat them differently on the basis
of such judgments.

Haddock Readings

16. Describe the roles of pattera and suruhana. According to ancient Chamorros, what caused
illness? What remedies were used to cure disease?

Pattera aka housewives were attendants who use traditional herbs and remedies and massages to help
women through their pregnancy, delivery, and postnatal periods. Suruhana were spiritual healers and a
subset of the Makhna and could speak to the aniti

Illness caused according to ancient Chamorro were the aniti

Remedies to cure disease were herbs and massages

17. What is an emerging health problem, and how can the Paterra be a solution? What may be the
cause of this emerging health problem?

The emerging health problem was lack of prenatal care and pattera can be a solution to treat midwives
in their pregnancy, delivery and postnatal period using traditional herb remedies and massages.
Causes is due to the lack of the prenatal care since women aren't getting medical care increase, closure
of most level public health clinics in favor of centralized “full-service clinic”, transportation issue.

18. How have medical care and resources changed from the Spanish colonial period to the US
colonial period?

Spanish period: observants of Chamorro culture was slow to handle Spanish interference when illness
came, brought customs, honored old traditions, blended

Us colonial period: better facilities to deal with disease such as leprosy

Japanese occupation: set up more nurses because of population growth; they set medical supplies, took
resources, treatment primarily for soldiers despite this, a lot of Chamorros were not angry and chose to
isolate themselves so disease is less transmittable which eventually led to rebirth of traditional
medicine.

Hattori Readings

19. Discuss Hattori’s interpretation of a) the statement “We have taught Guam to wash her face.”
and b) the cartoon “More Like His Dad Every Day.”

1a) Infantizing Guam = we need to be taught what to do; “Her” = submissive personification

1B cartoon

- Looks down on Guam

- Feminized child that needs steppingstones provided by uncle Sam
- Simplistic and immature

20. What is the relationship between health, politics, and science?

Colonialization: how the naval operated on Guam; to improve their image, bureaucracy of medicine =
low level of importance; navy kept pushing their image.

21. Explain the significance of soap in understanding colonialism.

First introduced from America; josepf Ada after learning how to make soap from the Spanish, decided to
make their own. Soap symbolizes American technology introduced and embedded in Chamorro culture.
This shows indigenous people accepting economic systems as their own and it shows the adoption of
capitalism as an aspect of colonialism

22. What is Guamitis and how is it significant in understanding health care on Guam from the
viewpoint of the US military and of Guamanians?
Guamitis was a “disease” whose symptoms were a loss of interest in routine affairs and life, apathy,
nostalgia, permutability, anxiety, and moodiness and to treat it they would have to leave Guam after
two years.

From the viewpoint of the us military was isolation and solitude, and for Guamanians, it made them look
bad.

Foliaki et. al Reading

23. Explain “research colonialism“ and its impact on health research in the Pacific.

Research colonialism was the research done in the early 1960s that first began with research done on
communicable diseases such as malaria and filariasis however, midway of 1960s, research then shifted
on the emphasis on diabetes and cardiovascular diseases. Its impact on health research in the pacific
was that it provided opportunities for pacific led research and training for pacific led researchers.

This led to two waves of research that happened around 1968. The first one was done using a survey in
Tokelau and between 1972 and 1973, the survey of nearly all the Tokelau residents from the adults to
the children were recorded using detailed examinations, including serum and urinary biochemical
analysis. This survey done here and by other researchers indicated that noncommunicable diseases like
diabetes were almost nonexistent in Polynesian populations maintaining a traditional lifestyle

A second research was done in the 1970s where individual health workers and social scientists from
Australia, New Zealand, and the united states and were collaborating with one another with other
regional health agencies including the south pacific commissions and world health organization and their
studies on cardiovascular diseases and other metabolic disorders help not just support earlier findings
on the role of social and environmental changes in the increase of non-communicable diseases in the
region.

24. Outline issues for further research.

Trainings should go beyond ad hoc training exercises for field work and incorporate formal
training exercises for fieldwork and incorporate formal training both locally and in
collaborations with established regional and international research institutions.
Most health research often fails to accommodate the perspective of “minority” ethic groups. It
cannot be assumed that when the research population is a majority group this will result in a
culturally appropriate research paradigm if researchers are mostly outsiders and outnumber
local researchers.